Project Methodology 5

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Appraisal Checklists

Health Evidence Bulletins - Wales: Questions to assist with the critical appraisal of a randomised controlled trial (Type II evidence)
Adapted from the CASP questions (taken from Guyatt et al. Users' guides to the medical literature. II How to use an article about therapy or prevention. Journal of the American Medical Association. 1993; 270: 2598-2601 and 271: 59-63) and Barker, JM. Project for the enhancement of the Welsh Protocols for Investment in Health Gain. Project Methodology. Cardiff: Duthie Library. UWCM, 1996. Egger et al.  How important are comprehensive literature searches and the assessment of trial quality in systematic reviews?  Health Technology Assessment 2003; 7(1)

Paper details Authors:

A/ What is this trial about and can I trust it?
    Screening questions.

  Yes Can't tell No
1. Is the trial relevant to the needs of the Project?      
2. Did the trial address a clearly focused issue?
in terms of:
  • the population studied,
  • the intervention given,
  • the outcomes considered.
3. Was there concealment of allocation?

Note whether:

  • the randomisation process was described explicitly eg the use of random number tables or coin flips;

  • there was some form of centralised randomisation scheme eg central allocation or use of sealed opaque envelopes.

4. Were all the patients who entered the trial properly accounted for at its conclusion?
  • was follow-up obtained for 80-100% of subjects?  Note % follow-up.
  • were patients analysed in the groups to which they were randomised?


Detailed questions

  Yes Can't tell No
5. Were patients, health workers and study personnel 'blind' to treatment?
  • patients?
  • health workers?
  • study personnel?
6. Were the groups similar at the start of the trial?
In terms of all the factors that might be relevant to the outcome:
age, sex, social class, life style etc.
7. Aside from the experimental intervention, were the groups treated equally?      

Is it worth continuing?


B/ What did they find?

8. How large was the treatment effect?
  • What outcomes were measured?
  • Take a note of the result(s) (eg odds ratio, number needed to treat) if provided.


9. How precise was the estimate of the treatment effect?
  • What are the confidence limits?
  • Do you feel confidence in the authors' use of statistics?



C/ Are the results relevant locally/to me?

Yes Can't tell No
10. Can the results be applied to the local population?
Do you think the patients covered by the trial are similar enough to your population? Consider culture, geography etc.
11. Were all important outcomes considered?
If not, does this effect the conclusion(s)?
12. Is any cost information provided? N/A
13. Accept for further use as Type II evidence? Refer to Team Leader


In the Draft Statement Remember to include the relevant target group (age range, sex etc.); the duration of the study, the measured outcomes/benefits with quantitative information if available and whether: 1.  Treatment allocation was concealed; 2.  An intention-to-treat analysis was carried out (include % follow-up); and 3. The trial was double (or triple) blind.

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